Nearly a third of partners, and a similar proportion of GPs involved in setting up a primary care network (PCN), say their CCG tried to influence which practices joined forces.
The findings come ahead of the 15 May deadline for practices across England to submit applications to form a PCN. All practices are expected to join a network by July - with the standard PCN expected to cover around 30,000 to 50,000 patients.
A total of 30% of the 215 GP partners who responded to GPonline's latest opinion survey, and 31% of 153 GPs involved in setting up a PCN who responded, said their CCG ‘has tried to influence’ which practices are in their PCN.
One GP partner responding to the survey said practices in her area had been ‘forced into PCN groups to suit the CCG’, while another said there had been ‘a definite top-down approach’ locally.
Some GPs reported being asked by CCGs to integrate with practices that ‘have a history of not working collaboratively’ or with whom they ‘did not really wish to associate’.
However, one GP said that although their CCG had originally ‘arranged [practices] into predetermined groups for discussion’ at a PCN meeting ‘based on assumptions’- commissioners had later proved flexible.
Others described how their CCGs had ‘given guidance’ but ultimately let GPs have the final say on PCN configuration. One GP partner said: ‘[The CCG] was keen to get geographically sensible groupings, [but] no pressure was applied.’
Nearly all (97%) GP partners taking part in the GPonline poll said their practice was planning to join a PCN, and the vast majority of doctors involved in setting up PCNs are partners. Among GPs who said they were involved in setting up a network, 86% were GP partners, while 9% were salaried and just 4% locums.
While many respondents said they thought practices coming together to form PCNs was ‘positive’ and ‘a good idea’ for general practice, others voiced doubts.
‘I feel this is yet another rushed reorganisation without real evidence [that] it will help the situation,’ one GP partner wrote. ‘We are already in a partnership of practices representing a large number of patients but with the way the funding is being allocated to PCNs we look like we will be forced to break up this group to form smaller networks. This seems ridiculous and shortsighted.’
Others were concerned that the formation of PCNs would create ‘yet more meetings and work’ for GPs. One GP said: ‘I already have to attend a meeting in my free time because there's no one else to cover the surgery. There's never remuneration for attending these meetings or for the time taken with all the reading. It's just another level of administration and increasing complexity.’
GPC executive team member Dr Krishna Kasaraneni told GPonline: ‘Ourselves and NHS England have been clear that it is down to practices to lead in the formation and running of PCNs. All practices that want to join PCNs should be supported by CCGs, working with the LMCs to ensure the networks are offering the best for patients, practices and staff across the area.’
Dr Graham Jackson, co-chair of NHS Clinical Commissioners (NHSCC) said: ‘CCGs have an important role to play in approving PCN registration forms, which will include proposed network membership.’
He highlighted that the specification for the network contract directed enhanced service (DES) - the contract for practices joining PCNs - stated that ‘commissioners should have reached agreement with practices on any issues relating to the proposals in registration forms, such as PCN list size and the network area’ by the end of May.
Dr Jackson added: ‘Specifically, CCGs must make sure that every resident within their CCG area is covered by a PCN. Some CCGs may well need to engage in local negotiations (with support from their LMCs) if any of their member practices are not covered by a PCN. NHSCC has always held that commissioners and practices must work in close partnership to establish and support PCNs.’
An NHS spokesperson said: 'There has been a huge amount of co-operation and enthusiasm between CCGs and family doctors and the NHS is confident there will be full PCN coverage by July 1, which will help lead to improved services for patients.'